Healthcare Provider Details

I. General information

NPI: 1417200239
Provider Name (Legal Business Name): JILL MARIE STEVENSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 OLD RIVER RD
BLUFFTON SC
29909-3952
US

IV. Provider business mailing address

231 SPRINGSIDE DR SUITE 205
AKRON OH
44333-4530
US

V. Phone/Fax

Practice location:
  • Phone: 419-307-0416
  • Fax:
Mailing address:
  • Phone: 330-666-9544
  • Fax: 330-670-8569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number21773
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: